The introduction of the Improving Access to Psychological Therapies scheme in primary mental health care has raised questions about mental health nurses’ role and function. This article considers some of the key questions around where and indeed whether nursing continues to have a place within primary mental health care.

KEY POINTS

The remit of Imp

Improving Access to Psychological Therapies (IAPT) is to provide timely and time-limited therapy

New roles in the IAPT framework mean nurses can access new training

Becoming part of the IAPT structure could give mental health nurses the opportunity to have their skills formally recognised

It is up to individual mental health nurses to decide whether they can work within an IAPT model

Nursing must fight to survive and establish its place within a changing healthcare environment

Sue Evershed is Lead Psychologist in the Personality Disorder Directorate at Rampton Hospital. She has previously worked as a Consultant Psychologist in the Learning Disability Directorate at Rampton Hospital, and prior to this she was employed by HM Prison Service, working with young offenders, high secure offenders, and ‘dangerous and disturbed’ prisoners in the first of the ‘special units’ at HMP Parkhurst. Her research interests currently include treatment outcome and process with personality disorder, including therapeutic alliance, therapeutic boundaries and therapy attrition.

Abstract:

A variety of therapies have been developed or adapted to treat personality disorder over recent years. This article will reviewskills-based treatments (as opposed to insight-based treatments).Two approaches are outlined: cognitive–behavioural therapy and dialectical behaviour therapy. The article details the underpinning theory and the model of personality disorder utilised by the two approaches, and describes how the therapy is applied. Evidenceof therapeutic efficacy is presented along with information about accessing training and therapy materials.

National Institute for Clinical Excellence updated guidelines for schizophrenia (2009) recommend two psychological treatments – cognitive behavioural therapy for psychosis (CBTp) and family intervention for psychosis (FI). Despite these recommendations being in place for nearly a decade, implementation problems remain, particularly for FI. It is argued that these problems can be overcome, if services prioritise improving access to psychological therapies for psychosis, and that carers in particular need their own services to be developed.

To provide a narrative review of recent research on the psychotherapeutic treatment of patients with personality disorders (PDs). We conducted PubMed and PsycINFO searches of recently published articles that reported on the treatment outcomes of psychotherapies for PDs. Our focus was on studies that used randomized controlled trial (RCT) methodology. The search period was from January 2006 to June 2009. The effectiveness of various psychotherapy treatment packages for PDs is well supported by favourable results from RCTs. Beneficial effects of psychotherapy included reduced symptomatology, improved social and interpersonal functioning, reduced frequency of maladaptive behaviours, and decreased hospitalization. Equivalent effects among the interventions we compared were common. Many of the treatments studied required only limited training by therapists. Most studies were focused on treating patients with borderline personality disorder (BPD). Some findings were suggestive of psychotherapy being cost-effective; however, few studies actually included formal cost analyses. Only one study included follow-up of treated patients beyond 1-year posttreatment. There is strong support for the use of psychotherapy to treat patients with PDs. However, most of the evidence is limited to BPD. The findings of recent studies hold promise for training and practice. Future research should attend to identification of appropriate patient-treatment matches, elucidation of active treatment ingredients, and illumination of factors that are common among treatments that account for their equivalent effects.

A systematic review of behavioral experiments vs. exposure alone in the treatment of anxiety disorders: A case of exposure while wearing the emperor’s new clothes? Clinical Psychology Review, Volume 30, Issue 5, July 2010, Pages 467-478

Dean McMillan & Rachel Lee

Department of Health Sciences and Hull York Medical School, Seebohm Rowntree Building, University of York, YO10 5DD, United Kingdom

Abstract:

There has been a longstanding debate about whether cognitive techniques in Cognitive Behavior Therapy add to effectiveness of behavioral ones. Cognitive proponents have suggested that behavioral experiments, a cognitive strategy, relative to exposure alone, a behavioral one, are an example of the value of cognitive interventions. Those who have argued that cognitive strategies may not be necessary have also recognized this as a key test. We conducted a systematic review and narrative synthesis of studies that compared these two techniques in the treatment of a range of anxiety difficulties in adults. PyscINFO, MEDLINE and EMBASE were searched from 1957 to 2008, reference lists were examined, and a citation search was conducted. Data were extracted to a standardized coding sheet, and at each stage of selection a proportion of citations were double-coded to establish reliability. 14 studies (total N = 644) met inclusion criteria covering obsessive compulsive disorder, panic, social anxiety and specific phobias. Although the methodological limitations of the studies, particularly the use of brief exposure durations and the possibility of therapeutic-allegiance effects, prevent definitive conclusions, there was some evidence that behavioral experiments were more effective than exposure alone.

Cognitive–behavioural therapy for depression in people with a somatic disease: meta-analysis of randomised controlled trials, The British Journal of Psychiatry (2010) 197: 11-19

Matthijs W. Beltman

Abstract:

Meta-analyses on psychological treatment for depression in individualswith a somatic disease are limited to specific underlying somaticdiseases, thereby neglecting the generalisability of the interventions.

Aims

To examine the effectiveness of cognitive–behaviouraltherapy (CBT) for depression in people with a diversity ofsomatic diseases.

Method

Meta-analysis of randomised controlled trials evaluating CBTfor depression in people with a somatic disease. Severity ofdepressive symptoms was pooled using the standardised meandifference (SMD).